{"id":8587,"date":"2021-08-12T13:12:43","date_gmt":"2021-08-12T13:12:43","guid":{"rendered":"https:\/\/fitproblog.mysites.io\/feet-and-footwear\/"},"modified":"2021-08-12T13:12:43","modified_gmt":"2021-08-12T13:12:43","slug":"feet-and-footwear","status":"publish","type":"post","link":"https:\/\/www.fitpro.com\/blog\/feet-and-footwear\/","title":{"rendered":"Feet and footwear"},"content":{"rendered":"

Feet and footwear<\/strong><\/p>\n

James Earls <\/strong>discusses the impact of wearing shoes on feet.<\/p>\n

A recent study found that walking speeds\u00a0in 85% of elderly men and 93% of elderly\u00a0women have reduced so much that they can no longer cross the road at speeds considered\u00a0safe1<\/sup>. Although this study\u00a0was only performed in England, the results are\u00a0in keeping with studies performed in Ireland, South Africa, Spain and the United States. It\u00a0is hard not to see how this may relate to other\u00a0statistics that show that 85% of the population is wearing incorrectly sized shoes2<\/sup>, that 87% of older adults have some form of foot dysfunction3<\/sup>, with up to 74% having a hallux valgus, and one in 40 people over the age of 50 suffer with a hallux rigidus4<\/sup>.<\/p>\n

In each category of dysfunction, female feet are worse than men\u2019s, and I am sure few people\u00a0would contest that women\u2019s footwear is less foot-shaped than men\u2019s (Figure 1). Women\u2019s shoes also tend to have higher heels, which places extra stress on the metatarsal heads, realigns the\u00a0ankle to a plantar flexed position and, over time, can shorten the gastrocnemius and stiffen the Achilles\u2019 tendon3<\/sup>.<\/p>\n

Each misalignment and every reduced range\u00a0of motion will affect bone and soft tissue function. There are many benefits to tensioning collagenous tissues\u00a0during natural movement, and joint and soft tissue alignments overlap to ensure the system\u00a0flows with ease. Changing toe alignment or artificially reducing the range of joint motion\u00a0robs the system of momentum and the force enhancements from pretensioning.<\/p>\n

Shoe design can affect the pretensioning of\u00a0the plantar tissues in many ways. The most obvious is the toe spring, the upward curve of the sole beyond the ball, which is often used by\u00a0manufacturers to compensate for the stiffness of the sole (Figure 2). If the material used for the sole of the shoe is difficult to bend, it will stop the\u00a0metatarsal joints from extending. Shoe manufacturers compensate for this with an in-built toe spring to exaggerate the ball of the shoe.<\/p>\n

The effect on the foot is to reduce or remove\u00a0toe extension and, by doing so, reduce the\u00a0amount of work performed by the flexor tissues. It should be no surprise that outsourcing the\u00a0work of the foot to the shoe causes the foot to weaken, as the muscles are no longer being used for deceleration and control. A study by\u00a0Sichting et al<\/em>5<\/sup> found that toe springs reduce the workload and decrease the stiffness of the medial longitudinal arch, an effect they\u00a0warn may have long-term consequences for foot health, as the intrinsic muscles become weaker over time due to underuse.<\/p>\n

However, we need to be aware to not fall foul of the appeal to nature argument. It is always\u00a0important to read research with a critical eye as we can learn a clinical lesson from the study. Sichting and colleagues show that toe springs divert work from the plantar tissues and into the form of the shoe, which is not a good\u00a0thing for a healthy foot. It is a totally different story if the foot is already challenged. In cases\u00a0of plantar heel pain, plantar fascia pain or metatarsalgia, toe springs could be a clinically useful device for the temporary unloading\u00a0of tissues that may be under stress. In cases\u00a0of plantar heel pain, plantar fascia pain or metatarsalgia, toe springs could be used to\u00a0off-load the tissues and give them time to heal\u00a0without requiring the client to completely rest.<\/p>\n

A comprehensive review of related literature\u00a0by Holowka and Lieberman6<\/sup> showed\u00a0that habitually shod populations generally had weaker feet and recorded lower height and\u00a0stiffness of the medial longitudinal arch than habitually unshod populations. In their study, Holowka and Lieberman showed that wearing minimalist shoes could significantly increase\u00a0the cross-sectional area of abductor hallucis and, to a lesser extent, the cross-sectional areas\u00a0of abductor digiti minimi and flexor digitorum\u00a0brevis. Minimalist shoes allow the foot to spread and the toes to extend, so it should\u00a0be no surprise that letting the foot follow its\u00a0natural function makes the associated muscles\u00a0work a little harder. These intrinsic muscles\u00a0form part of the \u2018foot core system\u2019 proposed\u00a0by McKeon et al<\/em>7<\/sup> and, like any \u2018core\u2019, the muscles\u00a0benefit from working out. Conveniently, we do\u00a0not need to go to the gym to exercise the feet,\u00a0we could be working them with every step \u2013 if\u00a0we are wearing the right shoes!<\/p>\n

As part of their construction, minimalist\u00a0shoes have flexible and thin soles that not\u00a0only allow the plantar tissues to engage but also enhance sensory stimulation. The foot can feel the surface more clearly and, by\u00a0stiffening the tissues, the mechanoreceptors\u00a0receive appropriate information regarding the pressure, shear and stretch that is unavailable\u00a0to them in a stiff, cramped shoe. Once again, though, modern shoes can offer something to\u00a0the pathological foot. As the major function of shoes is to protect the foot, we must consider those with challenged tissues. Both peripheral\u00a0vascular and neurological deficits can increase\u00a0sensitivity or, dangerously, decrease it to the extent that the client is unaware of any tissue damage. All too commonly in cases of diabetes, injury to the foot leads to complications that\u00a0require amputation. Ensuring properly fitted\u00a0shoes are worn can reduce injuries and should form part of any quality care package.<\/p>\n

In less serious conditions, such as plantar\u00a0fascia conditions, a shock-absorbing sole can temporarily reduce strain on the tissue and\u00a0speed recovery. In fact, any condition that has challenged the soft tissues can benefit from\u00a0some rest and recovery time and the support\u00a0given by a shoe. For example, reduced fat pad coverage can be compensated for with an absorbent heel as the calcaneal fat pads deform\u00a0up to 60% with minimalist shoes, but only 35%\u00a0in conventional running shoes.<\/p>\n

\"\"\"\"<\/p>\n

Figure 1: We are shaped by our environment. Every trainer knows the benefit of correct form and the dangers of incorrect mechanics but, yet, we still allow ourselves and our clients to perform tasks in shoes that alter the shape of our feet. We might feel fine in the short term but what are the long-term effects on feet that live in a shoe-shaped environment? (Image courtesy of Vivobarefoot)<\/p>\n

\"\"<\/p>\n

Figure 2: Just as we need to learn human anatomy to understand how the body functions, knowing the anatomy of a shoe can give us a better appreciation of how footwear can affect function.<\/p>\n

 <\/p>\n

References<\/strong><\/p>\n

    \n
  1. Asher L, Aresu M, Falaschetti E, Mindell J (2012), Most older pedestrians are unable to cross the road in time: a cross-sectional study, Age and Ageing<\/em>, 41(5): 690-94.<\/li>\n
  2. Tyrrell J, Jones S, Beaumont R, Astley C, Lovell R, Yaghootkar H, Tuke,M, Ruth K, Freathy R, Hirschhorn J, Wood A, Murray A, Weedon M, Frayling T (2016), Height, body mass index, and socioeconomic status: mendelian randomisation study in UK biobank, British Medical Journal, <\/em>352: i582.<\/li>\n
  3. Franklin S, Grey M, Heneghan N, Bowen L, Li F-X (2015), Barefoot vs common footwear: a systematic review of the kinematic, kinetic and muscle activity differences during walking, Gait & Posture, <\/em>42(3): 230-39.<\/li>\n
  4. Rodri\u0301guez-Sanz D, Tovaruela-Carrio\u0301n N, Lo\u0301pez-Lo\u0301pez D, Palomo-Lo\u0301pez P, Romero-Morales C, Navarro-Flores E, Calvo-Lobo C (2018), \u2018Foot disorders in the elderly: a mini-review,\u2019 Disease\u2013a\u2013Month, <\/em>64(3): 64-91.<\/li>\n
  5. Sichting F, Holowka N, Ebrecht F, Lieberman D (2020), \u2018Evolutionary anatomy of the plantar aponeurosis in primates, including humans,\u2019 Journal of Anatomy, <\/em>237(1): 85-104.<\/li>\n
  6. Holowka N, Wallace I, Lieberman D (2018), \u2018Foot strength and stiffness are related to footwear use in a comparison of minimally- vs. conventionally-shod populations,\u2019 Scientific Reports, <\/em>8(1): 3,679.<\/li>\n
  7. McKeon P, Hertel J, Bramble D, Davis I (2014), \u2018The foot core system: a new paradigm for understanding intrinsic foot muscle function,\u2019 British Journal of Sports Medicine, <\/em>49(5): 290.<\/li>\n<\/ol>\n

     <\/p>\n

    Many thanks to James Earls for offering all of the FitPro community a discount to the\u00a0Feet, Fascia & Function Summit on 20 November 2021.\u00a0<\/strong>You can attend the summit for just \u00a399 (currently \u00a3125, soon to go to \u00a3135!).<\/p>\n

    \"\"<\/a><\/p>\n

    The eventbrite link\u00a0<\/strong>is:\u00a0https:\/\/www.eventbrite.co.uk\/e\/feet-fascia-function-summit-2021-tickets-160522279459<\/a><\/strong><\/p>\n

    Use the following discount code: FitProDiscount<\/strong><\/p>\n

    Author Bio:<\/strong><\/p>\n

    \"James<\/p>\n

    Based in London, James Earls<\/strong> is a writer, lecturer and bodyworker, specialising in Myofascial Release and Comparative Anatomy. He is a graduate of the Gray Institute\u2019s GIFT training and recently completed an MSc in Human Anatomy and Evolution. James has authored two books \u2013 Fascial Release for Structural Balance and Born to Walk, and, in between walks and workouts, is currently working on a third.<\/p>\n

     <\/p>\n","protected":false},"excerpt":{"rendered":"

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